Provider Demographics
NPI:1679657704
Name:TITUS REGIONAL MEDICAL FOUNDATION
Entity type:Organization
Organization Name:TITUS REGIONAL MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:903-577-6066
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:STE #132
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2387
Mailing Address - Country:US
Mailing Address - Phone:903-572-6418
Mailing Address - Fax:903-572-6883
Practice Address - Street 1:2001 N JEFFERSON AVE
Practice Address - Street 2:STE #132
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2387
Practice Address - Country:US
Practice Address - Phone:903-572-6418
Practice Address - Fax:903-572-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 333600000X
TX114193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150851Medicaid
2096388OtherPK
TX149074Medicaid